MR imaging evaluation for the assessment of pelvic organ prolapse: a newer technique

Background: MRI is the newest technique used to evaluate patients with pelvic floor disorders. It allows relatively non-invasive, dynamic evaluation of all pelvic organs in multiple planes and can directly visualize the muscular and ligamentous pelvic floor support structures. Using MRI to evaluate pelvic floor disorders may be most helpful in patients with multicompartment findings or symptoms, posterior compartment abnormalities, severe prolapse, or recurrent pelvic floor symptoms after prior surgical repair. MRI is often able to reveal more extensive organ prolapse than physical examination alone.Methods: The present study was carried out in the Department of Radiodiagnosis and Obstetrics and Gynecology of Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh from November 2014 to October 2015. A total of 43 patients who had symptoms of pelvic floor dysfunction like uterine prolapse, urinary or rectal dysfunction were evaluated by high resolution USG. Patients with low lying uterus on USG were subjected to MRI. Before MRI, these patients were assessed by a Gynecologist, and a clinical diagnosis in form of the organ/organs prolapsed and the grade of individual prolapse was assigned and tabled in the prefixed format.Results: Prolapse is more common in patients with greater than 50 years age (63% patients). MRI picked up more lesions compared to clinical examination, 90% as compared to 82.5% on clinical examination. MRI has good correlation with surgery in diagnosing prolapse. Concomitant prolapse of the Anterior and Middle compartment is the most common clinical entity diagnosed on 52.5% patients in our set up. MRI has poor sensitivity in identifying posterior compartment prolapse. There is good agreement between the clinical grading and MRI grading (81.8% correlation).Conclusions: T MRI offers a novel approach of simultaneous imaging of all compartments of the female pelvis at a single setting. With lesser intraobserver variation and better visualization of the pelvic anatomy MRI would help in accurate staging and hence better outcomes in patients in terms of symptom relief

Study of inflammatory markers for COVID-19 in control population and in pregnant women: a systematic review

COVID-19 infection is an inflammatory state and has varied presentation ranging from mild to severe condition. The second wave of COVID-19 resulted in greater mortality and morbidity as compared to first wave both in general as well as in pregnant patient. As the progression of disease is rapid and fatal hence there is a need of reviewing relevant inflammatory markers for predicting the disease course and severity. The inflammatory markers considered are Interleukins, CRP, LDH, serum Ferritin, Neutrophil/ lymphocyte ratio and in some cases serum Procalcitonin. These markers are raised in other inflammatory conditions also and therefore the maximum predictability of various markers differs in different conditions. COVID-19 in pregnancy in itself is challenging as it alters the immunity and hemodynamic and therefore the value of these markers in pregnancy can affect the sensitivity and specificity in predicting the severity of the disease. This review will evaluate the role of inflammatory markers in general population as well as pregnancy with regards to their prognostication in assessing the disease severity

Visual Field Mapping by Tangent Screen and Humphrey Perimetry: A Comparative Study

Background and Objectives: (a) To compare manual tangent screen perimetry and automated Humphrey perimetry for visual field testing, and (b) to analyze whether manual tangent screen perimetry still has a role or it should be replaced by computerized automated Humphrey perimetry in physiology labs and clinical diagnostic settings.Methods: Study was done on 45 patients between 18 and 65 years of age that included 30 eyes of patients suffering from glaucoma/ other eye diseases giving rise to visual field defects, 5 eyes of patients suffering from neurological diseases and 10 eyes of normal subjects.All patients underwent perimetry examination by tangent screen at 1 meter distance (and 2 meter distance, if required) and automated Humphrey perimetry by Humphrey visual field analyzer (HFA) using 30-2 ‘white on white’ full threshold strategy. Tangent screen consists of black screen 2 meter square or 1 meter square. Accordingly, patient is seated at a distance of 2 meter or 1 meter respectively. A patient with organically constricted visual fields will show an increase in the size of the visual field when moved to a farther distance while a patient with functional visual field loss will often report the same absolute size of the field (tubular or gun-barrel field) to be consistent with their first field. This is clear evidence of functional visual field impairment.Results: Out of 45 patients, 29 were male and 16 were female. The age cases in the study ranged from 40-79 years with mean age of 60.70 years. Tangent screen perimetry was able to detect about 5 patients with early field defects and 15 patients with moderate/ advanced field defects. On the other hand, Humphrey automated perimetry was able to detect 10 patients with early field defects and 18 patients with moderate/ advanced field defects. While only 13.33% technicians preferred tangent screen perimetry, around three-fourths of the technicians found Humphrey automated perimetry more preferable. 91.11% technicians found HVF to be technically easier because the automated perimeter eliminates observer bias, is easier to perform and also overcomes the tedium of manual perimetry. Moreover, automated perimetry also uses quantified parameters while manual perimetry does not. On evaluating sensitivity and specificity of manual tangent screen perimeter using the Humphrey automated perimeter as the standard, the tests showed that the tangent screen perimeter had 75.75% sensitivity and 88.88% specificity. Since the mean time taken was more in automated perimetry: 474.5 sec, 474 sec and 459.9 sec versus 340.5 sec, 339.1 sec, and 339.1 sec in glaucoma, neurological and normal patients respectively; more patients-66% preferred tangent screen perimetry.Interpretation and Conclusions: Our results suggest that visual field testing with automated perimetry is superior to visual field testing with tangent screen perimetry. The automated perimeter picked up visual field defects in a larger number of eyes than the tangent screen perimeter. Visual field defects were more extensive on automated perimetry compared to tangent screen perimetry.The advantage of the HVF analyzer also lies in its ability to make use of quantified parameters like mean deviation and corrected pattern standard deviation to detect subtle worsening of visual field defect, with statistical level of confidence

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (=0.16). Both groups, achieved similar best corrected visual acuity (=0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS

Congenital cystic eye with multiple dermal appendages: a case report

BACKGROUND: A partial or complete failure in the involution of the primary optic vesicle resulting in the formation of a cyst is an extremely rare anomaly known as congenital cystic eye. The primary optic vesicle is formed but instead of the anterior part of the vesicle involuting to lie in apposition with the posterior part, a cyst persists at birth and replaces the eye. CASE PRESENTATION: We report a case of congenital cystic eye associated with multiple dermal appendages in a 1-day-old female child. This condition presented at birth as a large orbital mass in the left orbit that bulged forwards and stretched the eyelids. No globe or any other ocular structures were identified in the orbit. Multiple dermal appendages were present in the adjacent part of the face below the left orbit and on the upper part of the neck. CONCLUSIONS: Congenital cystic eye is an extremely rare condition and with only 28 previous cases reported in the literature. We present the second case of congenital cystic eye with multiple dermal appendages of the face and neck

Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS)

BACKGROUND: There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. METHODS AND FINDINGS: Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa). Prospective daily observational data was collected on clinical signs, supportive care, antibiotic treatment, microbiology, and 28-day mortality. Two prediction models were developed for (1) 28-day mortality from baseline variables (baseline NeoSep Severity Score); and (2) daily risk of death on IV antibiotics from daily updated assessments (NeoSep Recovery Score). Multivariable Cox regression models included a randomly selected 85% of infants, with 15% for validation. A total of 3,204 infants were enrolled, with median birth weight of 2,500 g (IQR 1,400 to 3,000) and postnatal age of 5 days (IQR 1 to 15). 206 different empiric antibiotic combinations were started in 3,141 infants, which were structured into 5 groups based on the World Health Organization (WHO) AWaRe classification. Approximately 25.9% (n = 814) of infants started WHO first line regimens (Group 1-Access) and 13.8% (n = 432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2-"Low" Watch). The largest group (34.0%, n = 1,068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3-"Medium" Watch), 18.0% (n = 566) started a carbapenem (Group 4-"High" Watch), and 1.8% (n = 57) a Reserve antibiotic (Group 5, largely colistin-based), and 728/2,880 (25.3%) of initial regimens in Groups 1 to 4 were escalated, mainly to carbapenems, usually for clinical deterioration (n = 480; 65.9%). A total of 564/3,195 infants (17.7%) were blood culture pathogen positive, of whom 62.9% (n = 355) had a gram-negative organism, predominantly Klebsiella pneumoniae (n = 132) or Acinetobacter spp. (n = 72). Both were commonly resistant to WHO-recommended regimens and to carbapenems in 43 (32.6%) and 50 (71.4%) of cases, respectively. MRSA accounted for 33 (61.1%) of 54 Staphylococcus aureus isolates. Overall, 350/3,204 infants died (11.3%; 95% CI 10.2% to 12.5%), 17.7% if blood cultures were positive for pathogens (95% CI 14.7% to 21.1%, n = 99/564). A baseline NeoSep Severity Score had a C-index of 0.76 (0.69 to 0.82) in the validation sample, with mortality of 1.6% (3/189; 95% CI: 0.5% to 4.6%), 11.0% (27/245; 7.7% to 15.6%), and 27.3% (12/44; 16.3% to 41.8%) in low (score 0 to 4), medium (5 to 8), and high (9 to 16) risk groups, respectively, with similar performance across subgroups. A related NeoSep Recovery Score had an area under the receiver operating curve for predicting death the next day between 0.8 and 0.9 over the first week. There was significant variation in outcomes between sites and external validation would strengthen score applicability. CONCLUSION: Antibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis. TRIAL REGISTRATION: ClinicalTrials.gov, (NCT03721302)

Effects of room acoustic on stereo and surround sound systems

A home theater system recreates the surround sound heard in cinemas and concerts in the listening room of any house. It is an extension of a stereo system to create a three-dimensional sound field. A Stereo system uses two channels to produce a wide soundstage along with some spatial information. Surround sound produces a sense of presence and realism unable to be produced by a stereo system. The aim of this study is to determine the effects of Room Acoustics on stereo and surround sound. It also involves the study of the characteristics of a home theater system along with their optimized placement in any room. A quantitative evaluation of the room acoustics effect is made by observing the signals from the microphones in the ears of an anthropomorphic manikin (KEMAR) as compared to qualitative evaluation by listeners. Both the stereo and surround sound characteristics are tabulated and analyzed. The measurements of frequency response and cross-correlations are done in three rooms (anechoic, reverberant and listening room) in this study. Then, the plots between the speaker and manikin are compared to evaluate the effect of different rooms on the measurements. The study shows that only in the anechoic room, the unadulterated program material gets to the listener. The cross correlation is the best measure of this condition. Correlation is also useful in speaker placement so that program material arrives at the listener 'in phase'. Transfer functions are useful in showing room modes in non ideal listening rooms.Electrical and Computer Engineerin

International Journal of Software and Web Sciences (IJSWS) www.iasir.net Survey on Acceptance Testing Technique

Abstract: Software testing is done to detect and correct software failures. Main purpose of testing is to check that software meets all specified requirements that guided its design and development. User Acceptance testing (UAT) is the key feature of software implementation. UAT is performed to ensure that the new system meets all the essential user requirements. It is the final testing activity performed by the customer to test for the completeness, correctness and consistency of the software